Aortic stenosis,angina pectoris,coronary artery disease

The data from 88 patients (pts) with aortic stenosis (AS) were reviewed to determine relationships between angina pectoris (AP) and coronary artery disease (CAD). Results of surgery performed in 81 of these pts was analyzed. All pts had coronary arterlograms, and lesions ≥ 50% were considered significant. Fifty-nine pts had an aortic valve gradient measured at catheterization ≥ 40 mmHg, and in 29 pts, AS was confirmed at operation. Sixty-eight pts (77%) experienced AP, and 32 had coexisting CAD (47%); 9 of 20 pts without AP had CAD (45%). There were no significant differences in the incidence of AP in pts divided into subgroups by the aortic valve gradient (40–50, 51–100, 101–200 mmHg) or age (40–59, 60–81 years. Also, no significant differences were found in the incidence or extent of CAD between the two age groups; the extent of CAD was similar regardless of the presence or absence of AP. In pts with AP (1) CAD was more likely in pts ≥ 60 years of age; (2) CAD was less likely when the aortic valve gradient was > 100 mmHg, suggesting that AP in these pts was due to hemodynamically severe AS. All pts with 3-vessel CAD experienced AP, and the aortic valve gradient was less in these pts than in those with no CAD or less extensive CAD. In 19 pts with combined AS and CAD who had both the aortic valve replaced and a revascularization operation only 1 of pts died in the hospital, while 3 of 19 pts with combined AS and CAD who had aortic valve replacement alone died. In this study a significant number of pts with AS experienced AP, and the presence or absence of AP did not predict coexisting CAD. Coronary arteriography is recommended in the evaluation of pts ≥ 40 years of age with AS. The operative mortality appears to be decreased in pts with AS and CAD who have combined surgery.     

静息心率与冠心病发病危险因素聚集性的关联

本文探讨了静息心率与冠心病发病危险因素高血压、高纤维蛋白原血症、高甘油三酯血症、高血糖聚集性的关联。发现超重（ＢＭＩ≥２５）及（或）男＞４５岁，女＞５５岁人群，平均静息心率＞８８次／分钟组上述两个以上危险因素聚集发生机率较６０次／分钟组增加约５０％。多因素Ｌｏｇｉｓｔｉｃ回归分析表明，调整年龄、体重指数两混杂因素影响后，在心率＞８８次／分钟人群则这种危险性仍明显增加（ＯＲ＝４．３，９５％可信限２．１～８．７），提示在超重及较年长人群中心率可能是一个简单的冠心病危险因素聚集发生的临床标志。     

Association of coronary calcification with obstructive disease in coronary arteries in Indian patients

A total of 1150 consecutive patients (1052 males and 98 females; age 51.2 +/- 10.1 years) with suspected coronary artery disease (Group I) were subjected to fluoroscopy for detection of coronary artery calcification (CAC) and coronary angiography. Another group (Group II) of 120 patients (95 males and 25 females; age 51.4 +/- 9.4 years) catheterized for cardiac diseases other than coronary artery disease (CAD) were subjected to the same protocol of fluoroscopy and coronary angiography to exclude incidental CAD in view of their age. CAC was present in 240 patients (20.0%) in Group I. Of these, 200 (83.4%) had triple-vessel disease (TVD); 20 (8.3%) had double-vessel disease (DVD); 19 (7.9%) had single-vessel disease (SVD); and 37 (15.4%) patients had left main coronary disease (LMCAD). Only one of these patients had insignificant CAD considered as "normal" coronary arteries (NC). Incidence of LMCAD, TVD, DVD, SVD, and NC in patients without CAC was 4.4%, 56.3%, 18.2%, 14.0%, and 11.5%, respectively. Incidence of CAC in patients with LMCAD, TVD, DVD, SVD, and NC was 48.1%, 28.1%, 10.8%, 13.0%, and 1.0% respectively. In Group II (n = 120), 24 patients (20%) had CAD, CAC was present in 5 patients with CAD (20.9%), and in two patients without CAD (2%). CAC is relatively uncommon in Indian CAD patients. Its presence, however, indicates severe multivessel disease.     

冠状动脉钙化积分相关临床因素分析

目的 评价冠状动脉(冠脉)钙化积分(CACS)的相关因素.方法 入选疑诊冠心病的患者141例,3个月内完成多层螺旋CT、脉搏波传导速度(PWV)、超声心动图及血生化检查,MDRD方程计算患者入院时估算肾小球滤过率(eGFR).根据冠脉钙化程度将病例分为3组:A组(CACS=0～10),B组(CACS=11～400),C组(CACS>400).结果 3组比较年龄、高血压病史、糖尿病史、二尖瓣钙化、主动脉瓣钙化、两侧臂踝指数低值、臂到踝的PWV高值、臂及踝平均动脉压高值、波形上升支时间高值差异均有统计学意义(P值均<0.05).多因素logistic回归分析显示:主动脉瓣钙化(P=0.000)、二尖瓣钙化(P=0.002)、波形上升支时间高值(P=0.009)和糖尿病(P=0.032)是严重冠脉钙化的独立相关因素.结论 疑诊冠心病的患者行多层螺旋CT检查前可行PWV和超声心动图检查,结合病史评估患者冠脉钙化的可能性及严重程度.     

Report: Association of coronary artery disease and valvular heart disease in chile

This study analyzes the prevalence of coronary artery disease (CAD) among patients with rheumatic valvular heart disease (VHD) in Chile. Coronary angiography was performed in all patients referred to cardiac catheterization with VHD who were over age 50 years and who had angina or ECG signs of ischemia. A total of 100 patients entered the study. Significant CAD (greater than 50% obstruction) was found in 14% of the cases: 7% in patients with mitral valve disease (MVD), 18% in aortic valve disease (AVD), and 21% in combined mitral and aortic valve disease (MAVD). Angina was present in 14% of the patients with MVD, 63% with AVD, and 53% with MAVD. Only 57% of patients with CAD had angina pectoris; 20% with angina had CAD. Hemodynamic parameters and left ventricular ejection fraction were not correlated with the presence or absence of CAD. We conclude that in patients with valvular heart disease, the incidence of CAD is lower in Chile than previously reported in the English literature. We confirmed the fact that angina is often not associated with CAD, and that CAD is often present in the absence of angina.     

红细胞分布宽度是预测冠状动脉粥样硬化性心脏病危险的标志物

<正>冠状动脉粥样硬化性心脏病(CAD)是严重威胁人类生命健康的重大疾病,其防治是全世界共同面临的重大的公共卫生问题。近些年来,我国的CAD发病率、住院率和院前死亡率持续攀升,目前每年有超过70万人死于CAD,1998至2008年间我国男性CAD发病率增加26.1%,女性CAD发病     

冠心病患者冠状动脉病变进展的相关危险因素的探讨

目的:探讨影响冠状动脉粥样硬化性心脏病患者冠状动脉病变进展的危险因素。方法:选择138例在航空总医院心内科复查冠状动脉造影的冠心病患者,根据2次冠状动脉造影情况,分为冠状动脉进展组(86例)和无进展组(52例)。比较两组患者性别、年龄、吸烟史、高血压病史、糖尿病史、BMI、LDL、TG、TC、HDL-C以及两组糖尿病患者Hb A1c水平。采用多元Logistic回归分析各相关因素对冠状动脉病变进展的影响。结果:与无进展组相比,进展组男性比例更高(70%vs.42%,P<0.05),吸烟者比例更高(34.9%vs.11.5%,P<0.05),糖尿病患者比例更高(65%vs.31%,P<0.001)。糖尿病患者糖化血红蛋白比无进展组明显升高[(8.2±1.0)%vs.(6.4±0.8)%,P<0.05]。两组LDL平均值无差异,但无进展组LDL-C<1.4 mmol/L的比例明显高于进展组(23%vs.9%,P=0.03)。Logistic回归分析显示,男性(OR=4.800,95%CI:4.250~5.160,P=0.021)、吸烟(OR=3.966,95%CI:3.345~4.532 P=0.046)、糖尿病史(OR=4.048,95%CI:3.827~4.324,P=0.008)、Hb Alc(OR=59.44,95%CI:56.34~62.56,P<0.001)是冠心病患者冠状动脉病变进展的危险因素。结论:男性、吸烟、糖尿病、Hb A1c水平是冠心病患者冠状动脉病变进展最主要的危险因素,LDL促进冠状动脉病变进展。戒烟、控制Hb A1c水平以及控制LDL-c<1.4 mmol/L对延缓冠状动脉病变进展意义重大。     

颈动脉和股动脉斑块及主动脉弓钙化与冠心病相关

目的 研究颈动脉和股动脉斑块及主动脉弓钙化与冠心病的关系.方法 病人121例,经桡动脉行冠状动脉造影,据造影结果分为正常冠状动脉组及冠心病组,冠心病组又分为1支病变组、2支病变组及3支病变组,分别予体表超声及X胸片检查颈动脉和股动脉斑块及主动脉弓钙化.结果 颈动脉和股动脉斑块及主动脉弓钙化是预测冠心病的有效指标,随斑块及主动脉弓钙化的发生,病变血管数增加.三者相比,颈动脉斑块预测冠心病的敏感性最高,股动脉斑块预测冠心病的特异性最高,而主动脉弓钙化往往与多支病变有关.当三者共存时,冠心病的发生率高达94.8%.结论 颈、股动脉斑块及主动脉弓钙化对冠心病有一定的预测价值.     

Aortic stiffness is increased in patients with premature coronary artery disease: A tissue Doppler imaging study

BackgroundAtherosclerosis and arterial stiffening may coexist and the correlation of these parameters in patients with premature coronary artery disease (CAD) has not been well elucidated. Tissue Doppler imaging of the ascending aorta may be used in the assessment of elastic properties of the great arteries.ObjectiveTo investigate the correlation between aortic stiffness and premature CAD using parameters derived from two-dimensional and tissue Doppler imaging (TDI) echocardiography of the ascending aorta.MethodsFifty consecutive subjects younger than 40 years old who were hospitalized with diagnosis of acute coronary syndrome and had undergone coronary angiography were recruited. The control group included 70 age–sex matched individuals without a diagnosis of CAD. Aortic stiffness index (SI), aortic distensibility (D), and pressure-strain elastic modulus (E_p) were calculated from the aortic diameters measured by two-dimensional M-mode echocardiography and blood pressure obtained by sphygmomanometry. Aortic systolic velocity (S_Ao), and early (E_Ao) and late (A_Ao) diastolic velocities were determined by pulse-wave TDI from the anterior wall of ascending aorta 3 cm above the aortic cusps in parasternal long-axis view.ResultsStiffness index was higher [median 5.40, interquartile range (IQR) 5.98 vs. median 4.14 IQR 2.43; p = 0.03] and distensibility was lower (median 2.86 × 10⁻⁶ cm²/dyn, IQR 2.51 × 10⁻⁶ cm²/dyn vs. median 3.46 × 10⁻⁶ cm²/dyn, IQR 2.38 × 10⁻⁶ cm²/dyn; p = 0.04) in patients with CAD compared to the control group. E_Ao was significantly lower in the CAD group (7.2 ± 1.8 cm/s vs. 9.2 ± 2.4 cm/s, p < 0.01). The difference in E_Ao remained significant when CAD patients with a left ventricular ejection fraction >55% was compared to the control group. S_Ao and A_Ao velocities of ascending aorta were similar in control and CAD groups. There was a significant correlation between E_Ao velocity and aortic stiffness index (r = −0.28, p = 0.01), distensibility (r = 0.19, p = 0.04) and elastic modulus (r = −0.24, p = 0.01). In multivariate regression analysis, decreased levels of high-density lipoprotein cholesterol [odds ratio (OR): 1.12 95% CI 1.06–1.19; p = 0.01] and E_Ao (OR: 1.41 95% CI 1.12–1.79; p = 0.01) measurements remained as the variables independently correlated with premature CAD in the study group.ConclusionArterial stiffness is increased in patients with premature CAD. E_Ao of the anterior wall of ascending aorta measured with pulse-wave TDI echocardiography is correlated with arterial stiffening and is decreased in patients with premature CAD.     

冠心病患者冠状动脉病变与心率变异性的关系

目的了解冠心病患者冠状动脉病变与心率变异性（HRV）的关系。方法回顾性分析111例患者冠状动脉造影及24小时动态心电图检查资料,按冠状动脉造影结果分为3组:冠状动脉造影完全正常（正常组）、至少有一支冠状动脉狭窄>50%（狭窄组）、至少有一支冠状动脉完全阻塞（闭塞组）;通过动态心电图检查分析HRV的时域指标:SDNN、SDANNind、SDNNind、rMSSD、PNN50。结果①随冠状动脉狭窄程度加重,SDNN、SDANNind、SDNNind逐渐下降,完全阻塞组这些指标下降最显著;②随冠状动脉病变支数增加,SDNN、SDANNind、SDNNind、rMSSD、PNN50有进一步下降趋势,但只有3支病变HRV下降才有统计学意义;③左冠状动脉病变SDNN、SDAN-Nind显著下降,而右冠状动脉病变下降不显著。结论冠心病患者HRV显著下降提示冠状动脉狭窄程度重、病变范围广、病变在左冠状动脉。     

Percutaneous coronary intervention for stable coronary artery disease

Patients with significant coronary artery stenoses are at increased risk of future cardiac events. However, in the absence of acute coronary syndrome or recent myocardial infarction and residual ischemia, elective percutaneous coronary intervention has not been shown to improve prognosis. Possible explanations for this might be the limited follow-up time adopted by most randomized trials comparing percutaneous coronary intervention with medical therapy, limited number of patients with proven ischemia enrolled in these trials, and adoption of complex, elaborate techniques that have not proved their usefulness. Published evidence identifies certain indications for percutaneous coronary intervention in patients with stable coronary lesions: demonstration of significant inducible ischemia, particularly in the context of a recent myocardial infarction; detection of unequivocally reduced fractional flow reserve; and specific angiographic features of coronary stenoses. Operators should take into account long-term consequences of adopted techniques rather than immediate angiographic results. We review existing evidence and provide our recommendations in this setting.     

冠状动脉0钙化积分人群非钙化性斑块的发生率及其危险因素分析简

目的 利用计算机断层扫描（computerized tomography,CT）冠状动脉成像,研究冠状动脉0钙化积分人群非钙化性斑块的发生率及管腔狭窄程度,并分析其相关危险因素.方法 对968例冠状动脉0钙化积分患者的影像学资料和临床资料进行回顾性分析,所有患者均行64层螺旋CT冠状动脉钙化积分扫描及CT冠状动脉成像检查;采用单因素分析和Logistic回归分析冠状动脉非钙化性斑块形成的相关危险因素.结果 968例患者中,203例（21.0％）检出非钙化性斑块,斑块导致轻度狭窄124例（61.1％）、中度狭窄53例（26.1％）、重度狭窄26例（12.8％）.Logistic回归分析显示原发性高血压（高血压）（OR=3.994,P=0.010）、男性（OR=2.663,P=0.000）、吸烟史（OR=1.376,P=0.001）、甘油三酯增高（OR=3.536,P=0.000）、高密度脂蛋白胆固醇降低（OR=0.653,P=0.008）为冠状动脉非钙化性斑块形成的危险因素.糖尿病史、血清甘油三酯和高密度脂蛋白胆固醇浓度与斑块导致的管腔狭窄程度有关.结论 冠状动脉0钙化积分人群中有相当比例的人存在非钙化性斑块,高血压、高脂血症为非钙化性斑块形成的两大独立危险因素.     

电子束CT检测冠状动脉钙化对诊断老年冠心病的价值

目的　探讨电子束CT检测冠状动脉钙化 (CAC)对诊断老年人冠心病的价值。方法　 2 2 9例老年患者行电子束CT检测CAC并计算每例的CAC总积分 ,行选择性冠状动脉造影以确定冠状动脉粥样硬化狭窄的有无及其程度。结果　 (1) 2 2 9例患者中 ,CAC检测阳性 2 2 0例 ,总阳性率 96 .0 7% ;造影显示有 2 13例存在不同程度的冠状动脉狭窄 ,其中 16 8例确诊为冠心病。 (2 )全组CAC诊断老年人冠心病的总体敏感性、特异性、阳性预测值和阴性预测值分别为 99%、13%、76 %和 89% ,诊断老年人冠状动脉粥样硬化的相应指标则分别为 97%、19%、94%和 33%。(3)老年男性组CAC诊断冠心病的敏感性较高特异性较低 ;老年女性则特异性较高而敏感性较低。综合考虑敏感性及特异性 ,对于老年男性 ,以CAC积分为 2 0 0作为诊断冠心病的分值较好 ,而对于老年女性则以 5 0作为诊断分值较佳。结论　电子束CT检测冠状动脉钙化对诊断老年人冠心病具有一定价值 ,但应结合性别和钙化分值进行综合分析。     

Altered serum level of cartilage oligomeric matrix protein and its association with coronary calcification in patients with coronary heart disease

Background Cartilage oligomeric matrix protein (COMP) is mainly found in the skeletal system and vascular smooth muscle cells. Recent researches showed that it had a protective function on blood vessels and could also inhibit vascular calcification. We investigated the serum COMPs in coronary heart disease (CHD) patients, and the relationship between serum COMP and the calcification of coronary artery. Methods A total of 233 consecutive chest pain patients who first underwent coronary angiography followed by multi-slice computed tomography (MSCT) within six months were recruited and divided into two groups according to the coronary angiography luminal diameter narrowing percentages: CHD group (diameter narrowing ≥ 50%, n = 194) and control group (diameter narrowing < 50%, n = 39). The Gensini score, Syntax score and coronary artery calcium score (CACs) were calculated. The serum COMP level was determined using ELISA. Results The levels of COMP were significantly higher in the CHD group than in the control group 155.7 (124.5–194.5) ng/mL vs. 128.4 (113.0–159.9) ng/mL, P = 0.019. There were no correlation between COMP, Gensini score, Syntax score, severity of coronary stenosis and the number of coronary artery with stenosis > 50%. The serum COMP was correlated with age (r = 0.294, P < 0.001), fasting glucose (r = 0.163, P = 0.015), HbA1c (r = 0.194, P = 0.015) and CACs (r = 0.137, P = 0.037). Stepwise linear regression analysis showed that COMP level and age were independent predictors of CACs in the CHD patients (β = 0.402, t = 2.612, P = 0.015; β = 0.472, t= 3.077, P = 0.005). Performance of COMP for predicting CHD was shown as area under curve (AUC): 0.632, 95% CI: 0.549–0.715 and upper tertile CACs was AUC: 0.602, 95% CI: 0.526–0.678 in receiver operating characteristic (ROC) curve analysis. Conclusion Calcification of coronary artery was an independent predictor of serum COMPs.     

冠状动脉粥样硬化性心脏病与缺血性脑卒中相关性研究进展

冠状动脉粥样硬化性心脏病(冠心病)和缺血性脑卒中是动脉粥样硬化性疾病中最主要的2种疾病,二者可以单独或合并发生,是引起死亡和功能缺陷的重要病因。2种疾病存在一些共同的危险因素,在疾病发生上有一定的联系。明确二者之间的相关性有助于动脉粥样硬化性疾病的预防及治疗,减轻疾病不良预后引起的负担,提高国民生存质量。目前有诸多研究致力于探究二者在发病机制、疾病进展、预后以及影像学表现上的关联,其中某些研究结果之间存在差异。现将相关最新研究结果综述如下。     

Anaemia and coronary artery disease severity in patients with heart failure

BACKGROUND: Anaemia is common in heart failure (HF) and associated with higher mortality. Exacerbation of myocardial ischemia in patients with heart failure, coronary disease, and anaemia patients has been suggested as a potential mechanism underlying this association. AIMS: The aim of this study was to evaluate the hypothesis that greater CAD severity would exacerbate the adverse effects of anaemia in HF. METHODS: We examined data on patients with symptomatic heart failure (NYHA class > or = II) undergoing coronary angiography between 1995 and 2003 (n = 4951). Patients with primary valvular or congenital heart disease were excluded. Cox proportional hazards modeling was used to evaluate the relationship between coronary disease severity (as defined by no. of diseased vessels) and hemoglobin concentration. RESULTS AND CONCLUSIONS: In patients with symptomatic HF undergoing coronary angiography, we found an interaction between hemoglobin and CAD severity (p = 0.003 for interaction). Contrary to our hypothesis, the mortality hazard associated with anaemia was greatest in patients without CAD and progressively lower with increasing CAD severity. These data suggest that anaemia may exert its effect on HF outcomes through mechanisms beyond simply the exacerbation of myocardial ischemia.     

Multiplane transoesophageal echocardiographic absence of thoracic aortic plaque is a powerful predictor for absence of significant coronary artery disease in valvular patients, even in the elderly: A large prospective study

AIMS: This study was conducted to examine whether detection of atheroscleroticaortic plaque by multiplane transoesophageal echocardiographycould predict the absence or presence of significant coronaryartery disease in young and elderly valvular patients. METHODS AND RESULTS: Clinical and angiographic features and transoesophageal echocardiographyfindings were prospectively analysed in 278 consecutive valvularpatients. In 93 patients with significant coronary artery disease,85 had thoracic aortic plaque on transoesophageal echocardiographystudies. In contrast, aortic plaque existed in only 33 of theremaining 185 patients with normal or mildly abnormal coronaryarteries. Therefore, the presence of aortic plaque on transoesophagealechocardiography studies had a sensitivity of 91%, a specificityof 82%, and positive and negative predictive values of 72% and95%, respectively, for significant coronary artery disease.In the 109 patients aged 70 years, these sensitivity, specificity,and positive and negative predictive values were 96%, 78%, 79%,and 96%, respectively. The above high negative predictive valuewas the major finding of this study and indicated that the absenceof thoracic plaque is a strong predictor for absence of significantcoronary artery disease. There was a significant relationshipbetween the degree of aortic intimal changes and the severityof coronary artery disease (P<0·0001). Multivariatelogistic regression analysis revealed that aortic plaque, angina,hypercholesterolaemia and age were significant predictors ofcoronary artery disease: aortic plaque was the most significantindependent predictor, even in patients 70 years. CONCLUSION: This large prospective study indicates that examination of thoracicatherosclerotic plaque, by multiplane transoesophageal echocardiography,is a marker for coronary artery disease, and is a particularlypowerful predictor for absence of significant coronary arterydisease in valvular patients, even in the elderly.